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P REVALENCE Remained stable over past 50 yrs and occurs similarly across different countries and cultures (Hafner et al., 1997) 10-18% of all Sz arise before age 18 and 1% before 10yrs old. 42% occur between 21-30. 66% between 20-40. Remschmidt and Theisen 2011

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S EX D IFFERENCES /O NSET About equally represented among children and adolescents however some studies: Under 13 and 15-19 yr. old boys develop Sz more frequently (Hafner et al., 2007) More frequent in girls 13-15 (Mehler-wex et al., 2004). Age of onset: Peaks in early-mid 20s for males, later 20s/ for females. Females more likely to have late onset (post 55yrs) Males generally worse premorbid adjustment, lower educational achievement, more prominent negative symptoms and cognitive impairment, and in general a worse outcome (Alvarez-Jimenez et al., 2012).

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C LINICAL P RESENTATION OF P OSITIVE SYMPTOMS IN EOS Hallucinations Auditory (commands, threats, laughter, humming, whistling) Visual, olfactory, gustatory, and tactile are rare, but more common in COS Delusions Ideas of reference Belief of persecution Bodily change Delusions of control Systematized delusions are very rare Thought distortions Insertions, breaks and interpolations in train of thought Vague and incoherent thinking that is not expressed well.

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D IFFERENTIAL D IAGNOSIS IN EOS Difficult. DSM-V: Delusions and hallucinations are usually less elaborate and must be distinguished from normal fantasy play. Disorganized speech and behavior commonly occurs in other disorders (See Table 3).

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S UMMARY OF G ENETIC AND N EUROBIOLOGICAL F ACTORS Genetics obviously play a role, but it isn’t incredibly robust. Certain genes like DISC-1 can contribute to neuroanatomical differences at a young age. Large volume differences in Lateral Ventricle. Structural differences in frontal cortex, hippocampus, and cerebellum. DA, 5-HT, and glutamate hypotheses may account for positive, negative, and cognitive symptoms, respectively.

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C OGNITION T ESTS C OMMONLY USED IN EOS Frangou 2013 * A big problem with using consistent measurements: National Institute of Mental Health MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Dr. Green at UCLA is a world leader in Sz research

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T RAJECTORY OF COGNITIVE DYSFUNCTION IN EOS Moving from premorbid to syndromal EOS had 1-1.5 SD worse on IQ tests compared to Adult onset. Big picture: Earlier presentation of symptoms, the more dysfunction later in life. Some areas of cognitive functioning found to be more pervasive. (Frangou 2013).

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E NVIRONMENTAL R ISK CONT. Migration Especially African-Caribbean in the UK Higher incidence rates (1.7-13.2) when the group’s position in society was considered disadvantaged. Urbanicity One of the most consistent findings: 38-67% more likely to develop schizophrenia (Pederson et al., 2004). Dose-response fashion (causality?) Several validity/conceptual problems Most likely due to social isolation

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T REATMENT None listed in Division 53 Pharmacological approach is generally the first line of defense. Second generation antipsychotics (atypical) are primarily antiserotonergic and dopamine altering. (e.g. clozapine, aripiprizole, resperidone, quietiapine, olanzapine) Originally thought to decrease positive and negative symptoms Extrapyramidal symptoms are less common Weight gain is common. First generation antipsychotics (typical) are antidopaminergic (e.g. Haloperidol, Chlorpromazine) Primarily work to decrease positive symptoms Tardive dyskinesia is a common side-effect

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A NTIPSYCHOTIC INTERVENTION IN A DOLESCENT OS: A R EVIEW Very few studies. Generally use Atypical, only aripiprozole is FDA approved. Cochrane review looked at 13 RCTs with over 1,100 participants. Global state, mental state, adverse effects (weight gain, sedation, motor effects), drop out rate were assessed. (Datta et al., 2013) Atypical vs. Placebo: No difference (more dropped out in the placebo group). No difference between AAs, except aripiprozole had less weight gain. No difference in AAs vs. TAs. Need more studies!

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T RAJECTORY OF COGNITIVE DYSFUNCTION IN EOS Big picture: Earlier presentation of symptoms, the more dysfunction later in life. Moving from premorbid to syndromal EOS had 1-1.5 SD worse on IQ tests compared to Adult onset Processing speed (Digit Symbol): Two SDs worse compared to HCs in one study() and AOS ES =.66 () Working Memory (Digit Span and 1-back) EOS compared to HC